DMV
DEPARTMENT OF TRANSPORTATION
DRIVER AND MOTOR VEHICLE SERVICES
1905 LANA AVE NE, SALEM OREGON 97314
Instructions for
Provisional Driver Improvement Restriction
to Expand Driving Privileges
INFORMATION
x The application to expand driving privileges during your 90-day provisional driver improvement restriction is processed at DMV
Headquarters. DMV field offices are not able to process the application.
x You must proactively complete an action meant to reduce the likelihood of being convicted of a traffic offense or being involved in a
traffic accident BEFORE applying for expanded driving privileges. The proactive actionmust have been completed since the last
incident that caused the restriction.
x If you drive outside your restricted driving privilege and are cited and convicted for violating your restriction, your license
will be suspended for six months under the Provisional Driver Improvement Program.
x Print or type all information.
x DMV has final authority to grant or deny this application.
x Fill out each section of the application according to the instructions on this page.
SECTION 1
DRIVER INFORMATION
Complete all information. You do not need to provide a mailing address if your residence and mailing address are the same. YOU MUST
LIST THE DRIVER IMPROVEMENT VIOLATIONS THAT CAUSED YOUR PROVISIONAL DRIVER IMPROVEMENTRESTRICTION. List the
conviction type (e.g., Speeding; Careless Driving). Identify as a preventable accident if you were involved in a preventable accident.
SECTION 2
PROACTIVE ACTION TAKEN
A proactive action can be a driver safety, defensive driving or driver improvement course; driving lessons with a certified commercial driver
training instructor; more driving time with a parent or legal guardian since the incident that caused the restriction; or some other action
demonstrating your progress toward the goal of reducing traffic convictions and especially accidents. Identify what type of proactive action
you have taken since the last violation that caused the restriction. The most common actions are:
x A classroom or online driver safety course, defensive driving course or driver improvement course.
x A professional driving lesson with a certified commercial driver training school instructor.
x More driving time with your parent or legal guardian since the last violation.
If you have completed a proactive action not listed, you must describe the action and explain the benefit. Call DMV Driver Safety at (503)
945-5079 to confirm the action is acceptable for the purposes of this application.
SECTION 3
PROOF OF PROACTIVE ACTION
You must provide the applicable proof of the proactive action when you submit your application.
xA course completion certificate from a GULYHUVDIHW\, defensive driving or driver improvement course.
x Confirmation from a certified driver training school instructor that you have completed driving lessons.
x The signature of your parent or legal guardian certifying in the application that you have spent additional driving time since the last
incident that caused the restriction for the purpose of improving skills and safe driving.
If you have completed a proactive action not listed in Section 2 of the application, you must have your parent or legal guardian sign a
statement that you have completed the action.
SECTION 4
PURPOSE OF DRIVING PRIVILEGE
Clearly state the purpose of the driving privilege with the reason you need to drive. Expansion of driving privileges will be granted when
there is no other alternative transportation available. Privileges to drive to and from school when there is public transportation or school bus
transportation available will not be granted.If you are requesting to drive to and from school for sports, band practice or another schoolrelated activity, you need to provide the name and address of the school. If you are requesting to drive to and from a relative’s house for
family matters, you must provide the address of the relative’s residence. The destination address must be provided for any purpose for
which you are applying.
SECTION 5
DAYS / &20087(TIMES
Provide the days and FRPPXWHtimesyou need to drive to and fromyour destination. Be specific. If you drive outside these times,you can
be cited for drivingoutsideyour restrictions. If you are convicted for driving outsideyour restriction,your licensewillbe suspendedfor six
monthsunderthe ProvisionalDriverImprovement3rogram.
SECTION 6
SIGNATURE
Sign and date the application.
SUBMIT APPLICATION
Mail the application with proof of your proactive action to:
Driver Safety Unit
Driver and Motor Vehicle Services
1905 Lana Avenue NE
Salem OR 97314
or you may fax to: (503) 945-5329
735-7389 ()
Page 1 of 2
DMV
DEPARTMENT OF TRANSPORTATION
DRIVER AND MOTOR VEHICLE SERVICES
1905 LANA AVE NE, SALEM OREGON 97314
Application for
Provisional Driver Improvement Restriction
to Expand Driving Privileges
SECTION 1
LAST NAME (please print)
DRIVER INFORMATION
FIRST NAME
MIDDLE NAME
ODL / CUSTOMER NUMBER
DATE OF BIRTH
CONTACT PHONE NUMBER
RESIDENCE ADDRESS (City, State, Zip Code)
MAILING ADDRESS IF DIFFERENT (City, State, Zip Code)
DRIVER IMPROVEMENT VIOLATIONS THAT CAUSED YOUR PROVISIONAL DRIVER IMPROVEMENT RESTRICTION /LVW&RQYLFWLRQV3UHYHQWDEOH$FFLGHQWV
SECTION 2
PROACTIVE ACTION TAKEN
CHECK THE BOX THAT DESCRIBES THE PROACTIVE ACTION YOU HAVE TAKEN SINCE THE LAST INCIDENT THAT CAUSED THE RESTRICTION.
Completed adriver safety, defensive driving, or driver improvement course (online courses accepted).
Completedprofessional driving lessonswith a certified commercial driver training school instructor.
Completedadditional driving timewith a parent/legal guardian.
Other.'HVFULEHBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB([SODLQEHQeILWBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB
SECTION 3
PROOF OF PROACTIVE ACTION
CHECK THE BOX DESCRIBING THE PROOF YOU SUBMITTED WITH THIS APPLICATION.
I am submitting adriver safety/ defensive driving/ driver improvement course completion certificate.
I am submitting confirmation from my instructor for completionof professionaldriving lessons.
Ihavecompleted additional drive timewith my parent/legal guardianwhose signature belowattests and certifies my
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I am the driver’s … SDUHQWor …OHJDOJXDUGLDQ The applicant has completed additional drive time with me for the purpose of improving skills
and safe driving.
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_______________________________________________
___________________________________________ ___________________
SIGNATURE (PARENT OR LEGAL GUARDIAN)
PRINTED NAME
DATE
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SECTION 4 PURPOSE OF DRIVING PRIVILEGE 6(&7,21'$<6&20087(7,0(6
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______________________________________________________
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______________________________________________________
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Church:([SODLQUHDVRQDQGSURYLGHQDPHDQGDGGUHVVRIFKXUFK
Family: Explain reason and provide name and address of destination: 0DUNGD\VUHTXLUHGIRUGULYLQJ
…Mon … Tues … Wed … Thurs … Fri … Sat … Sun
______________________________________________________
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Other Explain reason and provide name and address of destination:
______________________________________________________
______________________________________________________
SECTION 6
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SIGNATURE
SIGNATURE OF PROVISIONAL DRIVER
DATE SIGNED
X
735-7389 (-1)
Please mail or FAX all completed pages to DMV
at the address or fax number provided in the instructions.
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